Gastric Ulceration and the Pyloric Sphincteric Cylinder

Abstract

Johnson (1957, 1965) and Johnson et al. (1964) held that gastric ulcers should not only be classified anatomically according to their distance from the pylorus, but also in accordance with their associated acid-secretory or pathophysiological characteristics. While most gastric ulcer patients were acid hypo-secretors, some were moderate and others hypersecretors of acid. On this basis the following three types of gastric ulcers were recognized: type I consisted of those patients in whom the ulcer was situated to the left of and above the gastric angulus (the angulus being defined as the lowest point of the lesser curvature), without macroscopic abnormalities of the prepyloric region, the pylorus or duodenum; these cases were associated with a low level of acid secretion and possibly hyposecretion of mucus. Type II consisted of those cases in which a gastric ulcer to the left of the angulus was associated with, and probably secondary to, an ulcer or its scar in the pylorus or duodenum; these patients were moderate and sometimes hypersecretors of acid. Type III included all gastric ulcers on or near the pylorus, and might be combined with a duodenal ulcer or a type II gastric ulcer proximally; these patients usually had hypersecretion of acid. Type III was subdivided as follows: (1) ulcers within one inch (2.54 cm) of the pylorus, called true prepyloric ulcers; (2) ulcers to the right of the angulus but further than 2.54 cm from the pylorus, called “other antral” ulcers.